DISEASES

Many conditions can be successful treated or managed without surgery. Learn more about some of these common diseases, their symptoms and treatment options.

Crohn’s Disease

What is Crohn’s Disease?

Crohn’s disease is a chronic inflammatory process primarily involving the intestinal tract. Although it may involve any part of the digestive tract from the mouth to the anus, it most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum).

Crohn’s disease is a chronic condition and may recur at various times over a lifetime. Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return.

What are the symptoms of Crohn’s Disease?
Because Crohn’s disease can affect any part of the intestine, symptoms may vary greatly from patient to patient.
Common symptoms include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating.

Not all patients experience all of these symptoms, and some may experience none of them. Other symptoms may include anal pain or drainage, skin lesions, rectal abscess, fissure, and joint pain (arthritis).

Who does it affect?
Any age group may be affected, but the majority of patients are young adults between 16 and 40 years old. Crohn’s disease occurs most commonly in people living in northern climates. It affects men and women equally and appears to be common in some families. About 20 percent of people with Crohn’s disease have a relative, most often a brother or sister, and sometimes a parent or child, with some form of inflammatory bowel disease.

Crohn’s disease and a similar condition called ulcerative colitis are often grouped together as inflammatory bowel disease. The two diseases afflict an estimated two million individuals in the U.S.

What causes Crohn’s disease?
The exact cause is not known. However, current theories center on an immunologic (the body’s defense system) and/or bacterial cause.

Crohn’s disease is not contagious, but it does have a slight genetic, or inherited, tendency. An x-ray study of the small intestine may be used to diagnose Crohn’s disease.

How is Crohn’s disease treated?
Initial treatment is almost always with medication. There is no cure for Crohn’s disease, but medical therapy with one or more drugs provides a means to treat early Crohn’s disease and relieve its symptoms. The most common drugs prescribed are corticosteroids, such as prednisone and methylprednisolone, and various anti-inflammatory agents.

Other drugs occasionally used include 6-mercaptopurine and azathioprine, which are immunosuppressive. Metronidazole, an antibiotic with immune system effects, is frequently helpful in patients with anal disease.

In more advanced or complicated cases of Crohn’s disease, surgery may be recommended. Emergency surgery is sometimes necessary when complications, such as a perforation of the intestine, obstruction (blockage) of the bowel, or significant bleeding occur with Crohn’s disease. Other less urgent indications for surgery may include abscess formation, fistulas (abnormal communications from the intestine), severe anal disease or persistence of the disease despite appropriate drug treatment.

Not all patients with these or other complications require surgery. This decision is best reached through consultation with your gastroenterologist and your colon and rectal surgeon.

Shouldn’t surgery for Crohn’s disease be avoided at all costs?
While it is true that medical treatment is preferred as the initial form of therapy, it is important to realize that surgery is eventually required in up to three-fourths of all patients with Crohn’s. Many patients have suffered unnecessarily due to a mistaken belief that surgery for Crohn’s disease is dangerous or that it inevitably leads to complications.

Surgery is not a cure, although many patients never require additional operations. A conservative approach is frequently taken, with a limited resection of intestine (removal of the diseased portion of the bowel) being the most common procedure.

Surgery often provides effective long-term relief of symptoms and frequently limits or eliminates the need for ongoing use of prescribed medications. Surgical therapy is best conducted by a physician skilled and experienced in the management of Crohn’s disease.

Diverticular Disease

Diverticulosis of the colon is a common condition that afflicts about 50 percent of Americans by age 60 and nearly all by age 80. Only a small percentage of those with diverticulosis have symptoms, and even fewer will ever require surgery.

What is the difference between Diverticulosis and Diverticulitis?
Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.

What are the symptoms?
The major symptoms of diverticular disease are abdominal pain (usually in the lower left abdomen), diarrhea, cramps, alteration of bowel habit and occasionally, severe rectal bleeding. These symptoms occur in a small percentage of patients with the condition and are sometimes difficult to distinguish from Irritable Bowel Syndrome.

Diverticulitis, an infection of the diverticula, may cause one or more of the following symptoms: pain, chills, fever and change in bowel habits. More intense symptoms are associated with serious complications such as perforation, abscess or fistula formation.

What is the cause of Diverticular Disease?
Indications are that a low-fiber diet over the years creates increased colon pressure and results in pockets or diverticula.

How is Diverticular Disease treated?
Diverticulosis and diverticular disease are usually treated by diet and occasionally, medications to help control pain, cramps and changes in bowel habits. Increasing the amount of dietary fiber from grains, legumes, and vegetables, and sometimes restricting certain foods reduces the pressures in the colon, and complications are less likely to arise.

Diverticulitis requires more intense management. Mild cases may be managed without hospitalization, but this is a decision made by your physician. Treatment usually consists of oral antibiotics, dietary restrictions and possibly stool softeners. Severe cases require hospitalization with intravenous antibiotics and strict dietary restraints. Most acute attacks can be relieved this way.

Surgery is usually only recommended for recurrent episodes, complications or severe attacks when there’s little or no response to medication.

In surgery, usually part of the colon, commonly the left or sigmoid colon, is removed and the colon is hooked up, or anastomosed, again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks.

Pilonidal Disease

What is pilonidal disease and what causes it?
Pilonidal disease is a chronic infection of the skin in the region of the buttock crease. The condition results from a reaction to hairs embedded in the skin, commonly occurring in the cleft between the buttocks. The disease is more common in men than women and frequently occurs between puberty and age 40. It is also common in obese people and those with thick, stiff body hair.

What are the symptoms?
Symptoms vary from a small dimple to a large painful mass. Often the area will drain fluid that may be clear, cloudy or bloody. With infection, the area becomes red, tender, and the drainage (pus) will have a foul odor. The infection may also cause fever, malaise, or nausea.

There are several common patterns of this disease. Nearly all patients have an episode of an acute abscess where the area is swollen, tender, and may drain pus. After the abscess resolves, either by itself or with medical assistance, many patients develop a pilonidal sinus. The sinus is a cavity below the skin surface that connects to the surface with one or more small openings or tracts. Although a few of these sinus tracts may resolve without therapy, most patients need a small operation to eliminate them.

A small number of patients develop recurrent infections and inflammation of these sinus tracts. The chronic disease causes episodes of swelling, pain, and drainage. Surgery is almost always required to resolve this condition.

How is pilonidal disease treated?
An acute abscess is managed with an incision, drained to release the pus, and reduce inflammation and pain. This procedure is usually performed in the office with local anesthesia. A chronic sinus will usually need to be excised or surgically opened.

Complex or recurrent disease must be treated surgically. Procedures vary from unroofing the sinuses to excision and possible closure with flaps. Larger operations require longer healing times. If the wound is left open, it will require dressing or packing to keep it clean.

Although it may take several weeks to heal, the success rate with open wounds is higher. Closure with flaps is a bigger operation that has a higher chance of infection; however, it may be required in some patients. Your surgeon will discuss these options with you and help you select the appropriate operation.

What care is required after surgery?
If the wound can be closed, it will need to be kept clean and dry until the skin is completely healed. If the wound must be left open, dressings or packing will be needed to help remove secretions and to allow the wound to heal from the bottom up.

After healing, the skin in the buttocks crease must be kept clean and free of hair. This is accomplished by shaving or using a hair removal agent every two or three weeks until age 30. After age 30, the hair shaft thins, becomes softer and the buttock cleft becomes less deep.

If you are suffering from any of these conditions, or experiencing symptoms, please contact Colon and Rectal Specialists to make an appointment in any of our Richmond area locations.